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Colon CancerAnother arena in which estrogen use as part of HRT confers benefit is in preventing colon cancer. This cancer occurs more often in women than in men and is the third leading cancer in terms of incidence and cancer deaths in women.(52) The incidence of colon cancer rises at age 40 and peaks between age 60 to 75 years. According to American Cancer Society estimates, in 1997 there were 48,600 new cases of colon cancer in women and 24,000 related deaths.(52) Even though mortality rates for colon cancer have fallen 25% among women in the last 20 years, it remains the third leading cause of cancer deaths in this group.(53)The concept that postmenopausal HRT may decrease the risk of colorectal cancer has received considerable attention, even though estrogen has no indication for this use. Some 20 epidemiologic studies have been published that examined this relationship.(54) The majority of these suggest an inverse, protective effect for HRT, particularly with current use. For the studies shown in Figure 8, current/recent use was defined as use within 1 year of colorectal cancer diagnosis. These trials, including 2 meta-analyses, show a clear beneficial effect for estrogen on colorectal cancer.(55-66) Although the precise mechanism for how estrogen might reduce colon cancer risk is unknown, it has been hypothesized that it affects bile acid metabolism or promotes tumor suppressor activity through estrogen receptors.(54) Around the time of menopause, colon cancer and preventive measures, including HRT, should be part of the discussions between women and nurses (Table 6). Counseling should include the American Cancer Society recommendations for annual digital rectal exam (DRE) and fecal occult blood testing as well as a flexible sigmoidoscopy every 5 years or colonoscopy every 10 years.
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